Basic Information
| Provider Information | |||||||||
| NPI: | 1598913808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7720 W SAHARA AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891172754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022289888 | ||||||||
| FaxNumber: | 8669200799 | ||||||||
| Practice Location | |||||||||
| Address1: | 3802 MEADOWS LN | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891073112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023138446 | ||||||||
| FaxNumber: | 7023848446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 11/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1119 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA1119 | 01 | NV | NV PA LICENSE | OTHER |